Variations in trajectories of emotional and behavioural symptoms in children and young people with pre-existing mental health and neurodevelopmental conditions before and during the COVID-19 pandemic: a nested data linkage clinical cohort study

Abstract

Background: children and young people with pre-existing mental health and neurodevelopmental conditions may have experienced heterogeneous mental health impacts during the COVID-19 pandemic, but what facts may explain these variations are still unclear. We aimed to examine variations in the longitudinal trajectories of emotional and behavioural symptoms before and during the COVID-19 pandemic in the United Kingdom (UK).

Methods: we used a novel nested clinical cohort study, linking the Maudsley Child and Young People Health and Experience Research (CYPHER) survey and electronic health records (EHRs) data of mental health service users (aged 5 to 17 years old) in South London and Maudsley NHS Foundation Trust, UK, on 1st June 2020 (n=388). Composite emotional and behavioural scores, including internalising and externalising symptoms, were assessed in June-September 2020 and February-March 2021 by the Maudsley CYPHER survey and the Strengths and Difficulties Questionnaire from EHRs was used to supplement data pre-pandemic (2019-March 2020) and during the pandemic (2020 and 2021). Sociodemographic characteristics and diagnoses were extracted from EHRs. Relative symptom trajectories were modelled with predictors using linear mixed models.

Results: relative emotional and behavioural symptoms were not significantly different from pre-pandemic to 2021, but variations were found across predictors. Those who were female (vs male; b = 0.19, 95% CI 0.02 to 0.36), lived in deprived neighbourhoods (vs non-deprived; b = 0.19, 95% CI 0.03 to 0.36), and had a diagnosis of autism (vs emotional disorder; b = 0.33, 95% CI 0.13 to 0.53) had relatively higher emotional symptoms pre- and during pandemic. Those who were Black (vs White; b = -0.48, 95% CI -0.82 to -0.14) or who did not state their ethnicity (b = -0.47, 95% CI -0.82 to -0.12) had relatively higher decreases in emotional symptoms between pre-pandemic and 2020. Those who had a diagnosis of intellectual disability (vs without) had greater relative decrease in emotional symptoms between pre-pandemic and 2020 (b = -0.94, 95% CI -1.60 to -0.28) and 2021 (b = -2.02, 95% CI -2.46 to -1.58). Those who were younger (vs older; b = -0.03, 95% CI -0.06 to -0.01) and had a diagnosis of autism (vs emotional disorder; b = 0.40, 95% CI 0.20 to 0.60) or attention-deficit hyperactivity disorder (vs emotional disorder; b = 0.43, 95% CI 0.19 to 0.66) had relatively higher behavioural symptoms pre- and during pandemic.

Conclusion: emotional and behavioural symptoms were high and relatively stable across pre- and during pandemic timepoints. Relatively worse emotional and behavioural symptoms were observed in children and young people who were younger, female, lived in deprived neighbourhoods, and had a diagnosis of a neurodevelopmental condition. However, some effects might reflect distinctive features between groups rather than pandemic-specific differences. Future research should examine longer-term mental health impacts of the pandemic across clinical groups and potential mechanisms of change.

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ORCID for Valeria Parlatini: orcid.org/0000-0002-4754-2494

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